Provider Demographics
NPI:1558393595
Name:TAYLOR, MARK W (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:W
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3602 S 19TH STREET
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405
Mailing Address - Country:US
Mailing Address - Phone:253-759-5555
Mailing Address - Fax:253-830-5420
Practice Address - Street 1:4700 POINT FOSDICK DRIVE NW
Practice Address - Street 2:STE 112
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335
Practice Address - Country:US
Practice Address - Phone:253-759-5555
Practice Address - Fax:253-830-5420
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2013-03-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WA33887207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8194854Medicaid
WAG29086Medicare UPIN
WA8194854Medicaid